Discussion
This study reports a case who suffered from toxic epidermal necrolysis
following COVID-19 vaccination with Sinopharm COVID-19 vaccine
(BBIBP-CorV). It is highly suspected that the offending agent is the
vaccine since other causes such as medications couldn’t cause this
phenomenon in the aforementioned timetable.
SJS/TEN is a spectrum of delayed hypersensitivity skin reactions that
are potentially fatal. The most prominent cause for these reactions is
medications and drugs such as sulfonamides and antiepileptics such as
lamotrigine. Infectious diseases such as mycoplasma pneumonia and HIV
infections are also known to have caused this reaction. Vaccine-related
TEN/SJS is a relatively rare concept and even though multiple cases of
MMR, DTP, and influenza vaccine-induced TEN/SJS have been reported, the
relation between the vaccines and TEN/SJS has not been established
[7].TEN/SJS usually starts the presentation with flu-like symptoms
which are consecutively followed by a dusky rash, crusting, targetoid
lesions, purpuric macules with full-thickness epidermal necrosis, and
extensive erosion. This spectrum of reaction can involve mucus membranes
which could impair oral intake. It has been suggested by several studies
that a hypersensitivity reaction with cytotoxic T cells which is
mediated by CD8+ lymphocytes could be the cause. It has been suggested
that the cytotoxic T cells cause the damage by releasing enzymes such as
granulysin and perforin [5].
COVID-19 vaccines are designed to combat the infection via different
methods. Some such as the AstraZeneca vaccine uses vectors while the
Pfizer vaccine uses mRNAs to introduce spike proteins to immune cells.
In this case, the Sinopharm vaccine is an inactivated virus vaccine
[1]. Up to now, COVID-19 vaccine-related SJS and TEN have also been
reported (Table 1). The majority of cases are women with 6 cases.
Reactions occurred after both the first dose and second (6 and 3 cases),
respectively (in one case it was not defined as to whether the first or
the second dose was responsible for the reaction). The mean age of
patients was 56.5 (sd:13.23) years old. Meanwhile, the time to the onset
of the presentation ranged from 6 hours to two weeks but most of them
happened within 4.32 (SD:4.05) days. The reaction resolved on average in
21.3 (SD:14.14) days.
COVID-19 vaccinations are widely used and are proved to protect against
severe infection and such instances are considered rare complications.
However, reporting these severe side effects should not prevent the
vaccine from being injected, and the fact that should be mentioned is
doctors and health care providers should be vigilant to such adverse
outcomes and must provide immediate care.
(Table 1)